Financial Operations Recovery Specialist II

Elevance Health•Indianapolis, IN

10d•$23 - $35•Remote

About The Position

The Financial Operations Recovery Specialist II is responsible for discovering, validating, recovering, and adjusting claims overpayments. The role may include duties related to cash receipts, cash application, claim audit collections, overpayment vendor validation, and claim adjustments. This position audits paid claims for identified overpayments using systems-based queries, specialized reporting, and other research to confirm recoverability and compliance with standard operating procedures and business requirements. It handles more complex issues, including coordination of benefits, Medicare, and medical policies, and collaborates regularly with other departments and contract managers to support customer satisfaction and resolve contractual issues. The specialist may conduct collection activities to recover overpayments and maintain unprocessed cash, accounts receivable processes, and other cash applications. The role also researches voluntary refunds for accuracy and requires accurate balancing of all accounts. The role is primarily virtual full-time, with in-person training sessions required. Candidates generally must live within a reasonable commuting distance of an office unless an accommodation is granted.

Requirements

High school diploma or equivalent.
At least 2 years of claims processing and/or customer service experience, or an equivalent combination of education and experience.

Nice To Haves

AA/AS or higher-level degree.
Experience performing post-pay claim validation to confirm recoverable overpayments.
Experience in claims recovery, overpayment identification, or accounts receivable processes.
Experience working in a high-volume, production-based claims environment.
Strong attention to detail and ability to meet productivity and quality benchmarks.
Knowledge of claims systems, edits, and validation workflows.
Familiarity with medical claims, including Medicare, coordination of benefits (COB), and medical policy review.
Ability to identify discrepancies and follow defined escalation processes.
Knowledge of medical coding.

Responsibilities

Audit paid claims for identified overpayments using systems-based queries, specialized reporting, and other research.
Confirm overpayment recoverability and alignment with SOPs and business requirements.
Handle complex matters involving coordination of benefits, Medicare, and medical policies.
Work with staff in other departments to support customer satisfaction.
Work with contract managers to identify and correct contractual issues when applicable.
Conduct collection activities to recover overpayments and maintain unprocessed cash, accounts receivable processes, and other cash applications as required.
Research voluntary refunds for accuracy.
Accurately balance all accounts.